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General NPI Number Information
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NPI Number | 1003423609
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Entity Type | Organization
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Legal Business Name | ARIZONA CENTERS FOR ORTHOBIOLOGICS, LLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 9475 E IRONWOOD SQUARE DR STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4576
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Country | US
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Telephone | 480-778-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 9475 E IRONWOOD SQUARE DR STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4576
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Country | US
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Telephone | 480-778-1400
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/DIRECTOR OF NURSING
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Name | TINA MANKIN
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Credential |
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Telephone | 602-510-3203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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